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Individual

JOHN DAVID WILSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
701 GROVE RD, ER ADMINISTRATION, GREENVILLE, SC 29605
(864) 455-6372
Mailing address
1 INDEPENDENCE PT STE 212, GREENVILLE, SC 29615-4536
(864) 797-6174

Taxonomy

Speciality
Code
Description
License number
State
207PP0204X
Pediatric Emergency Medicine (Emergency Medicine) Physician
Primary
14469
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
144695
SC
01
20004420
SELECT HEATLTH
SC
01
576007863
BCBS
SC
01
930129083
MEDICARE RAILROAD
SC
Enumeration date
09/22/2006
Last updated
07/26/2018
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